Ane­ka Lee

The Uni­ver­si­ty of the West In­dies yes­ter­day de­fend­ed the doc­tor who per­formed the C-sec­tion which led to the death of a ba­by boy at the Mt Hope Ma­ter­ni­ty Hos­pi­tal on Car­ni­val Sat­ur­day. It al­so de­fend­ed the ab­sence of two of its con­sul­tants who are at­tached to the North Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA). The de­fence came in the face of a bar­rage of me­dia re­ports and pub­lic de­bate over whether the doc­tor who per­formed the surgery on ex­pec­tant moth­er, Quel­ly Ann Cot­tle, was qual­i­fied to do so with­out help from the con­sul­tants.

The child, who was to be named Sime­on, died af­ter be­ing cut on the head dur­ing the surgery.The NCRHA has since sus­pend­ed the doc­tor with ba­sic pay pend­ing a full probe in­to the mat­ter. Health Min­is­ter Fuad Khan is al­so now in the process of es­tab­lish­ing an in­de­pen­dent team to in­ves­ti­gate the mat­ter, hav­ing re­ceived a pre­lim­i­nary re­port from the NCRHA.

But in a state­ment yes­ter­day, UWI in­sist­ed that prop­er op­er­at­ing pro­ce­dures were fol­lowed and the doc­tor was not on­ly prop­er­ly qual­i­fied to con­duct the surgery but al­so did not need the as­sis­tance of the con­sul­tants.UWI not­ed that the doc­tor, a spe­cial­ist reg­is­trar, was an ex­pe­ri­enced sur­geon who, in "the last two years alone," has per­formed "over 100 suc­cess­ful C-sec­tions at the Mt Hope Ma­ter­ni­ty Hos­pi­tal, in­clud­ing those for high risk preg­nan­cies."

Seek­ing to clar­i­fy work­ing pro­to­col, UWI said "stan­dard prac­tice un­der the Trinidad and To­ba­go health care sys­tem does not re­quire an on-call con­sul­tant to be present at the time of a C-sec­tion be­ing con­duct­ed, un­less there is a spe­cial need to do so," adding that with the op­er­at­ing spe­cial­ist reg­is­trar's ex­pe­ri­ence "the UWI con­sul­tant who was on call, and was ac­ces­si­ble, was not re­quest­ed to be in at­ten­dance."

Apart from not­ing that the on-call con­sul­tant was avail­able but was not re­quest­ed to be in at­ten­dance for the surgery, UWI said the oth­er con­sul­tant was on pre-ap­proved leave which the NCRHA was aware of.UWI, how­ev­er, said it was sad­dened by the child's death and of­fered con­do­lences to the fam­i­ly.

Ex­perts con­cerned

Dr Petronel­la Man­ning-Al­leyne, who worked for 26 years in pub­lic ser­vice and was, at the time of her for­mal re­tire­ment in 2008, the coun­try's on­ly neo-na­tol­o­gist–a pae­di­atric spe­cial­ist trained to han­dle the most com­plex and high risk sit­u­a­tions in­volv­ing new­borns–said she had nev­er con­front­ed any­thing of this na­ture.She said yes­ter­day: "I can­not com­pre­hend this. There is al­ways a risk that the ba­by could get cut but it's not com­mon and there is no way I have seen some­thing like this."

How­ev­er, Dr David Bratt, paed­i­tri­cian and T&T Guardian colum­nist, saw the in­ci­dent as a re­flec­tion of the coun­try's high in­fant mor­tal­i­ty rate which, he said, cur­rent­ly stood at 25.74 deaths per 1,000."It has got­ten worse in the last ten years," he said, adding that no ex­pla­na­tion has been of­fered be­cause "no one wants to take re­spon­si­bil­i­ty."Asked about in­creased in­fant mor­tal­i­ty rates yes­ter­day, Khan ex­plained that num­bers may be in­flat­ed be­cause of how "the count­ing takes place."

"We in­clude still births and ba­bies from 24-26 weeks who we try to save," he said.Khan said he asked the ques­tion of Unicef and learned that in oth­er coun­tries, ba­by deaths were on­ly count­ed in in­fants over 36 weeks ges­ta­tion and did not in­clude still births.He con­ced­ed, how­ev­er, that "even one death is too much" and rather than set a tar­get for im­prov­ing neo-na­tal fa­tal­i­ty rates, his min­istry's aim was "to go for ze­ro."